Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes.

OBJECTIVE: This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND: Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD: We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS: Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION: Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.

Quantifying the qualitative: exploring epistemic network analysis as a method to study work system interactions.

Studying interactions faces methodological challenges and existing methods, such as configural diagramming, have limitations. This work demonstrates Epistemic Network Analysis (ENA) as an analytical method to construct configural diagrams. We demonstrated ENA as an analytical tool by applying this method to study dementia caregiver work systems. We conducted 20 semi-structured interviews with caregivers to collect caregiving experiences. Guided by the Patient Work System model, we conducted a directed content analysis to identify work system components and used ENA to study interactions between components. By using ENA to create configural diagrams, we identified five frequently occurring interactions, compared work system configurations of caregivers providing care at home and away from home. Although we were underpowered to determine statistically significant differences, we identified visual and qualitative differences. Our results demonstrate the capability of ENA as an analytical method for studying work system interactions through configural diagramming. Practitioner summary: A new methodology, Epistemic Network Analysis (ENA), was presented to better support the study of work system interactions through configural diagramming. ENA was applied to qualitative data to demonstrate the capabilities of this method to construct configural diagrams of the work system. This study successfully demonstrated that ENA can visually represent and describe work system configurations.

Single molecule magnet behaviour in a square planar S = 1/2 Co(ii) complex and spin-state assignment of multiple relaxation modes.

We report the first example of field-induced single molecule magnet (SMM) behaviour in a square-planar S = 1/2 Co(ii) pincer complex [(PNNNP)CoBr]Br (2). The related five-coordinate complexes [(PCNCP)CoBr2] (1) and [(PONOP)CoBr2] (3) also exhibit SMM properties. Partial spin crossover displayed by 3 allows for assignment of distinct relaxation modes to each spin state.

O-O Radical Coupling: From Detailed Mechanistic Understanding to Enhanced Water Oxidation Catalysis.

A deeper mechanistic understanding of the key O-O bond formation step of water oxidation by the [Ru(bda)(L)2] (bdaH2 = 2,2'-bipyridine-6,6'-dicarboxylic acid; L is a pyridine or isoquinoline derivative) family of catalysts is reached through harmonious experimental and computational studies of two series of modified catalysts with systematic variations in the axial ligands. The introduction of halogen and electron-donating substituents in [Ru(bda)(4-X-py)2] and [Ru(bda)(6-X-isq)2] (X is H, Cl, Br, and I for the pyridine series and H, F, Cl, Br, and OMe for the isoquinoline series) enhances the noncovalent interactions between the axial ligands in the transition state for the bimolecular O-O coupling, resulting in a lower activation barrier and faster catalysis. From detailed transition state calculations in combination with experimental kinetic studies, we find that the main contributor to the free energy of activation is entropy due to the highly organized transition states, which is contrary to other reports. Previous work has considered only the electronic influence of the substituents, suggesting electron-withdrawing groups accelerate catalysis, but we show that a balance between polarizability and favorable π-π interactions is the key, leading to rationally devised improvements. Our calculations predict the catalysts with the lowest Δ G⧧ for the O-O coupling step to be [Ru(bda)(4-I-py)2] and [Ru(bda)(6,7-(OMe)2-isq)2] for the pyridine and isoquinoline families, respectively. Our experimental results corroborate these predictions: the turnover frequency for [Ru(bda)(4-I-py)2] (330 s-1) is a 10-fold enhancement with respect to that of [Ru(bda)(py)2], and the turnover frequency for [Ru(bda)(6-OMe-isq)2] reaches 1270 s-1, two times faster than [Ru(bda)(isq)2].

O-O bond formation in ruthenium-catalyzed water oxidation: single-site nucleophilic attack vs. O-O radical coupling.

In this review we discuss at the mechanistic level the different steps involved in water oxidation catalysis with ruthenium-based molecular catalysts. We have chosen to focus on ruthenium-based catalysts to provide a more coherent discussion and because of the availability of detailed mechanistic studies for these systems but many of the aspects presented in this review are applicable to other systems as well. The water oxidation cycle has been divided in four major steps: water oxidative activation, O-O bond formation, oxidative activation of peroxide intermediates, and O2 evolution. A significant portion of the review is dedicated to the O-O bond formation step as the key step in water oxidation catalysis. The two main pathways to accomplish this step, single-site water nucleophilic attack and O-O radical coupling, are discussed in detail and compared in terms of their potential use in photoelectrochemical cells for solar fuels generation.

Lability and Basicity of Bipyridine-Carboxylate-Phosphonate Ligand Accelerate Single-Site Water Oxidation by Ruthenium-Based Molecular Catalysts.

A critical step in creating an artificial photosynthesis system for energy storage is designing catalysts that can thrive in an assembled device. Single-site catalysts have an advantage over bimolecular catalysts because they remain effective when immobilized. Hybrid water oxidation catalysts described here, combining the features of single-site bis-phosphonate catalysts and fast bimolecular bis-carboxylate catalysts, have reached turnover frequencies over 100 s-1, faster than both related catalysts under identical conditions. The new [(bpHc)Ru(L)2] (bpH2cH = 2,2'-bipyridine-6-phosphonic acid-6'-carboxylic acid, L = 4-picoline or isoquinoline) catalysts proceed through a single-site water nucleophilic attack pathway. The pendant phosphonate base mediates O-O bond formation via intramolecular atom-proton transfer with a calculated barrier of only 9.1 kcal/mol. Additionally, the labile carboxylate group allows water to bind early in the catalytic cycle, allowing intramolecular proton-coupled electron transfer to lower the potentials for oxidation steps and catalysis. That a single-site catalyst can be this fast lends credence to the possibility that the oxygen evolving complex adopts a similar mechanism.

Manipulating the Rate-Limiting Step in Water Oxidation Catalysis by Ruthenium Bipyridine-Dicarboxylate Complexes.

In order to gain a deeper mechanistic understanding of water oxidation by [(bda)Ru(L)2] catalysts (bdaH2 = [2,2'-bipyridine]-6,6'-dicarboxylic acid; L = pyridine-type ligand), a series of modified catalysts with one and two trifluoromethyl groups in the 4 position of the bda2- ligand was synthesized and studied using stopped-flow kinetics. The additional -CF3 groups increased the oxidation potentials for the catalysts and enhanced the rate of electrocatalytic water oxidation at low pH. Stopped-flow measurements of cerium(IV)-driven water oxidation at pH 1 revealed two distinct kinetic regimes depending on catalyst concentration. At relatively high catalyst concentration (ca. ≥10-4 M), the rate-determining step (RDS) was a proton-coupled oxidation of the catalyst by cerium(IV) with direct kinetic isotope effects (KIE > 1). At low catalyst concentration (ca. ≤10-6 M), the RDS was a bimolecular step with kH/kD ≈ 0.8. The results support a catalytic mechanism involving coupling of two catalyst molecules. The rate constants for both RDSs were determined for all six catalysts studied. The presence of -CF3 groups had inverse effects on the two steps, with the oxidation step being fastest for the unsubstituted complexes and the bimolecular step being faster for the most electron-deficient complexes. Though the axial ligands studied here did not significantly affect the oxidation potentials of the catalysts, the nature of the ligand was found to be important not only in the bimolecular step but also in facilitating electron transfer from the metal center to the sacrificial oxidant.

Spin-state diversity in a series of Co(ii) PNP pincer bromide complexes.

We describe the structural and electronic impacts of modifying the bridging atom in a family of Co(ii) pincer complexes with the formula Co(t-Bu)2PEPyEP(t-Bu)2Br2 (Py = pyridine, E = CH2, NH, and O for compounds 1-3, respectively). Structural characterization by single crystal X-ray diffraction indicates that compounds 1 and 3 are 5-coordinate complexes with both bromides bound to the Co(ii) ion, while compound 2 is square planar with one bromide in the outer coordination sphere. The reduction potentials of 1-3, characterized by cyclic voltammetry, are consistent with the increasing electron-withdrawing character of the pincer ligand as the linker (E) between the pyridine and phosphine arms becomes more electronegative. Magnetic property studies of compounds 1 and 2 confirm high- and low-spin behavior, respectively, through a broad temperature range. However, complex 3 features an unusual combination of high spin S = 3/2 Co(ii) and temperature dependent spin-crossover between S = 3/2 and S = 1/2 states. The different magnetic behaviors observed among the three CoBr2 pincer complexes reflects the importance of small ligand perturbations on overall coordination geometry and resulting spin state properties.

Water Oxidation by Ruthenium Complexes Incorporating Multifunctional Bipyridyl Diphosphonate Ligands.

We describe herein the synthesis and characterization of ruthenium complexes with multifunctional bipyridyl diphosphonate ligands as well as initial water oxidation studies. In these complexes, the phosphonate groups provide redox-potential leveling through charge compensation and σ donation to allow facile access to high oxidation states. These complexes display unique pH-dependent electrochemistry associated with deprotonation of the phosphonic acid groups. The position of these groups allows them to shuttle protons in and out of the catalytic site and reduce activation barriers. A mechanism for water oxidation by these catalysts is proposed on the basis of experimental results and DFT calculations. The unprecedented attack of water at a neutral six-coordinate [Ru(IV) ] center to yield an anionic seven-coordinate [Ru(IV) -OH](-) intermediate is one of the key steps of a single-site mechanism in which all species are anionic or neutral. These complexes are among the fastest single-site catalysts reported to date.

Reactivity of a series of isostructural cobalt pincer complexes with CO2, CO, and H(+).

The preparation and characterization of a series of isostructural cobalt complexes [Co(t-Bu)2P(E)Py(E)P(t-Bu)2(CH3CN)2][BF4]2 (Py = pyridine, E = CH2, NH, O, and X = BF4 (1a-c)) and the corresponding one-electron reduced analogues [Co(t-Bu)2P(E)Py(E)P(t-Bu)2(CH3CN)2][BF4]2 (2a-c) are reported. The reactivity of the reduced cobalt complexes with CO2, CO, and H(+) to generate intermediates in a CO2 to CO and H2O reduction cycle are described. The reduction of 1a-c and subsequent reactivity with CO2 was investigated by cyclic voltammetry, and for 1a also by infrared spectroelectrochemistry. The corresponding CO complexes of (2a-c) were prepared, and the Co-CO bond strengths were characterized by IR spectroscopy. Quantum mechanical methods (B3LYP-d3 with solvation) were used to characterize the competitive reactivity of the reduced cobalt centers with H(+) versus CO2. By investigating a series of isostructural complexes, correlations in reactivity with ligand electron withdrawing effects are made.

Synthesis and characterization of a redox-active bis(thiophenolato)amide ligand, [SNS]3-, and the homoleptic tungsten complexes, W[SNS]2 and W[ONO]2.

A new tridentate redox-active ligand platform, derived from bis(2-mercapto-p-tolyl)amine, [SNS(cat)]H(3), has been prepared in high yields by a four-step procedure starting from commericially available bis(p-tolyl)amine. The redox-active pincer-type ligand has been coordinated to tungsten to afford the six-coordinate, homoleptic complex W[SNS](2). To benchmark the redox behavior of the [SNS] ligand, the analogous tungsten complex of the well-known redox-active bis(3,5-di-tert-butylphenolato)amide ligand, W[ONO](2), also has been prepared. Both complexes show two reversible reductions and two partially reversible oxidations. Structural, spectroscopic, and electrochemical data all indicate that W[ONO](2) is best described as a tungsten(VI) metal center coordinated to two [ONO(cat)](3-) ligands. In contrast, experimental data suggests a higher degree of S→W π donation, giving the W[SNS](2) complex non-innocent electronic character that can be described as a tungsten(IV) metal center coordinated to two [SNS(sq)](2-) ligands.

Coordination effects on electron distributions for rhodium complexes of the redox-active bis(3,5-di-tert-butyl-2-phenolate)amide ligand.

New rhodium complexes of bis(3,5-di-tert-butyl-2-phenol)amine ([ONO(cat)]H(3)) were synthesized, and their electronic properties were investigated. These compounds were prepared by combining [ONO(q)]K and [(cod)Rh(µ-Cl)](2) in the presence of an auxiliary donor ligand to yield complexes of the type [ONO]RhL(n) (n = 3, L = py (1); n = 2, L = PMe(3) (2a), L = PMe(2)Ph (2b), PMePh(2) (2c), PPh(3) (2d)). Single-crystal X-ray diffraction studies on [ONO]Rh(py)(3) (1) revealed a six-coordinate, octahedral rhodium complex. In the case of [ONO]Rh(PMe(3))(2) (2a), X-ray diffraction showed a five-coordinate, distorted square-pyramidal coordination environment around the rhodium center. While 1 is static on the NMR time scale, complexes 2a-d are fluxional, displaying both rapid isomerization of the square-pyramidal structure and exchange of coordinated and free phosphine ligands. UV-vis spectroscopy shows stark electronic differences between 1 and 2a-d. Whereas 1 displays a strong absorbance at 380 nm with a much weaker band at 585 nm in the absorption spectrum, complexes 2a-d display an intense (ε > 10(4) M(-1) cm(-1)), low-energy absorption band in the region 580-640 nm; however, in the cases of 2a and 2b, the addition of excess phosphine resulted in changes to the UV-vis spectrum indicating the formation of six-coordinate adducts [ONO]Rh(PMe(3))(3) (3a) and [ONO]Rh(PMe(2)Ph)(3) (3b), respectively. The experimental and DFT computational data for the six-coordinate complexes 1, 3a, and 3b are consistent with their formulation as classical, d(6), pseudo-octahedral, coordination complexes. In the five-coordinate complexes 2a-2d, π-bonding between the rhodium center and the [ONO] ligand leads to a high degree of covalency and metal-ligand electron distributions that are not accurately described by formal oxidation state assignments.

Ligand effects on the oxidative addition of halogens to (dpp-nacnac(R))Rh(phdi).

The treatment of (dpp-nacnac(R))Rh(phdi) {(dpp-nacnac(R))(-) = CH[C(R)(N-(i)Pr2C6H3)]2(-); R = CH3, CF3; phdi = 9,10-phenanthrenediimine} with X2 oxidants afforded octahedral rhodium(III) products in the case of X = Cl and Br. The octahedral complexes exhibit well-behaved cyclic voltammograms in which a two-electron reduction is observed to regenerate the initial rhodium(I) complex. When treated with I2, (dpp-nacnac(CH3))Rh(phdi) produced a square pyramidal η(1)-I2 complex, which was characterized by NMR and UV-vis spectroscopies, mass spectrometry, and X-ray crystallography. The more electron poor complex (dpp-nacnac(CF3))Rh(phdi) reacted with I2 to give a mixture of two products that were identified by (1)H NMR spectroscopy as a square pyramidal η(1)-I2 complex and an octahedral diiodide complex. Reaction of the square pyramidal (dpp-nacnac(CH3))Rh(I2)(phdi) with HBF4 resulted in protonation of the (dpp-nacnac(CH3))(-) backbone to provide an octahedral rhodium(III) diiodide species. These reactions highlight the impact that changes in the electron-withdrawing nature of the supporting ligands can have on the reactivity at the metal center.

Redox behavior of rhodium 9,10-phenanthrenediimine complexes.

New square-planar rhodium complexes of the redox-active ligand 9,10-phenenthrenediimine (phdi) have been prepared and studied. The complexes [dpp-nacnac(CH3)]Rh(phdi) (2a; [dpp-nacnac(CH3)](-) = CH[C(Me)(N-(i)Pr(2)C(6)H(3))](2)(-)) and [dpp-nacnac(CF3)]Rh(phdi) (2b; [dpp-nacnac(CF3)](-) = CH[C(CF(3))(N-(i)Pr(2)C(6)H(3))](2)(-)) have been prepared from the corresponding [nacnac]Rh(CO)(2) synthons by treatment with Me(3)NO in the presence of the phdi ligand. Complexes 2a and 2b are diamagnetic, and their absorption spectra are dominated by intense charge-transfer transitions throughout the visible region. Electrochemical studies indicate that both the phdi ligand and the rhodium metal center are redox-active, with the [nacnac](-) ligands serving to modulate the one-electron-oxidation and -reduction redox potentials. In the case of 2a, chemical oxidation and reduction reactions provided access to the one-electron-oxidized cation, [2a](+), and one-electron-reduced anion, [2a](-), the latter of which has been characterized in the solid state by single-crystal X-ray diffraction. Solution electron paramagnetic resonance spectra of [2a](+) and [2a](-) are consistent with S = (1)/(2) spin systems, but surprisingly the low-temperature spectrum of [2a](-) shows a high degree of rhombicity, suggestive of rhodium(II) character in the reduced anion.

A randomized controlled trial of simulation-based teaching versus traditional instruction in medicine: a pilot study among clinical medical students.

OBJECTIVE: To compare simulator-based teaching with traditional instruction among clinical medical students. METHODS: Randomized controlled trial with written pre-post testing. Third-year medical students (n = 38) received either a myocardial infarction (MI) simulation followed by a reactive airways disease (RAD) lecture, or a RAD simulation followed by an MI lecture. RESULTS: Mean pre-post test score improvement was seen across teaching modalities (overall change score [simulation] = 8.8 [95% CI = 2.3-15.3], pretest [62.7]; change score [lecture] = 11.3 [95% CI = 5.7-16.9], pretest [59.7]). However, no significant differences were observed between simulator-based teaching and lecture, in either subject domain. CONCLUSIONS: After a single instructional session for clinical medical students, differences between simulator-based teaching and lecture could not be established by the written test protocols used in this pilot. Future studies should consider the effects of iterative exposure assessed by clinical performance measures across multiple centers.

Assessment of a clinical performance evaluation tool for use in a simulator-based testing environment: a pilot study.

PURPOSE: This study assessed a clinical performance evaluation tool for use in a simulator-based testing environment. METHOD: Twenty-three subjects were evaluated during five standardized encounters using a patient simulator (six emergency medicine students, seven house officers, ten chief resident-fellows). Performance in each 15-minute session was compared with performance on an identical number of oral objective-structured clinical examination (OSCE) sessions used as controls. Each was scored by a faculty rater using a scoring system previously validated for oral certification examinations in emergency medicine (eight skills rated 1-8; passing = 5.75). RESULTS: On both simulator exams and oral controls, chief resident-fellows earned (mean) "passing" scores [sim = 6.4 (95% CI: 6.0-6.8), oral = 6.4 (95% CI: 6.1-6.7)]; house officers earned "borderline" scores [sim = 5.6 (95% CI: 5.2-5.9), oral = 5.5 (95% CI: 5.0-5.9)]; and students earned "failing" scores [sim = 4.3 (95% CI: 3.8-4.7), oral = 4.5 (95% CI: 3.8-5.1)]. There were significant differences among mean scores for the three cohorts, for both oral and simulator test arms (p <.01). CONCLUSIONS: In this pilot, a standardized oral OSCE scoring system performed equally well in a simulator-based testing environment.